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Integrated approaches yield positive results

Focusing on prevention and treatment, the current strategy to fight malaria is yielding positive results.

Prevention includes long-lasting insecticide-treated nets and indoor residual spraying with insecticides that kill malaria parasites, both cost-effective preventive measures.

Yet, treatment is needed to save lives and eliminate malaria parasites, preventing further transmission of the disease. Since 2004, the World Health Organization (WHO) recommends the use of artemisinin-based combination therapies (ACTs) and as a result, most African countries have adopted ACTs as a first-line treatment.

Rapid diagnostic tests (RDTs) also play an important role in fighting drug resistance by ensuring that ACTs are only given to patients who actually need them. The WHO recommends that all patients be diagnosed prior to ACT treatment, with the exception of children under five in endemic areas, who should be treated presumptively.

This integrated approach has demon­strated highly positive patient impact. In Zambia for instance, using ACTs, bed nets and indoor spraying has reduced malaria in-patient cases by 61%, and malaria in-patient deaths by approxi­mately 66%, between 2003 and 2007.1

In the Tigray region of Northern Ethiopia in 2005, the combination of long-lasting insecticidal nets (LLINs) to all children under five years old or to all households and distribution of ACT in the public sector from 2005 to 2007 was associated with substantial declines of in-patient malaria cases and deaths. Data from selected health facilities showed that in-patient malaria cases and deaths in children under five in Ethiopia fell by 73% and 62%, respectively, between 2005 and 2007.2

Rwanda, which adopted the Novartis ACT as first-line therapy in 2006, also reported a significant decline in malaria incidence. Between 2005 and 2010, malaria incidence decreased by 70%, while malaria cases declined by 60% and malaria deaths by 54%. Further, malaria prevalence among women has been halved compared with 2008. This decrease is attributed to several measures including the distribution of LLINs, availability of ACTs in all public health facilities and improved patient awareness.3

Beyond prevention and treatment, building capacity in malaria-endemic countries to strengthen their healthcare systems and deliver high-quality interventions is essential to ensuring long-lasting health impacts.

  1. Chizema-Kawesha E, Mukonka V, Mwanza M et al. Evidence of substantial nationwide reduction of malaria cases and deaths due to scale-up of malaria control activities in Zambia, 2001–2008. World Health Organization, Zambia 19–23 January. Impact Evaluation Mission Report.
  2. Otten M, Aregawi M, Were W, Karema C, Medin A, Bekele W et al. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment. Malar J 2009, 8:14.
  3. National Institute of Statistics of Rwanda. Rwanda Demographic and Health Survey 2010. Available at: